Mepivacaine

Indications

Mepivacaine is used for: Infiltration Anesthesia

Adult Dose

Infiltration Anesthesia Up to 400 mg (80 mL of 0.5% or 40 mL of 1% solution) Cervical/Brachial/Intercostal or Pudendal Block 50-400 mg (5-40 mL) of 1% or 100-400 mg (5-20 mL) 2% solution; for pudental block inject one half total dose each side; not to exceed 400 mg Transvaginal Block Up to 300 mg (30 mL of 1% solution); inject one half total dose each side; not to exceed 300 mg Paracervical Block Up to 200 mg (20 mL of 1% solution); inject one half total dose each side; not to exceed 200 mg

Child Dose

Renal Dose

Administration

Usually no more than 400 mg/dose; doses up to 550 mg has been used but rare & given no more frequently than q1.5hr; no more than 1000 mg in 24 hours Use preservative-free preparations for spinal or epidural anesthesia

Contra Indications

Hypersensitivity to mepivacaine or amide anesthetics, sensitivity to parabens

Precautions

Some formulations may contain sulfites History of malignant hyperthermia Monitor patient's state of consciousness following the injection; anxiety, dizziness, restlessness, tremors, depression, or blurred vision may be signs of CNS toxicity DO NOT use solutions with epinephrine in distal areas of body (eg, digit, nose, ear) Respiratory arrest reported with use Unintentional intravascular injection may result in seizures Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action Risk of chondrolysis if receiving continuous intra-articular infusion following arthroscopic or other surgical procedures Methemoglobinemia Use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly; patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition Advise patients or caregivers to seek immediate medical attention if patient experiences the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue; discontinue drug and any other oxidizing agents; depending on severity of signs and symptoms, patients may respond to supportive care, including oxygen therapy and hydration; a more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen

Pregnancy-Lactation

Pregnancy Category: C Lactation: Not known if excreted in breast milk

Interactions

Adverse Effects

Side effects of Mepivacaine : Frequency Not Defined Systemic dose-related toxicity Underventilation/apnea ("Total or High Spinal"), Hypotension Acidosis Systemic diseases which alter protein production/competition of other drugs for protein binding sites Angioneurotic edema (including laryngeal edema), syncope, depression of the myocardium, decreased cardiac output, heart block, hypotension (or sometimes hypertension), bradycardia, ventricular arrhythmias, and possibly cardiac arrest Excitation and/or depression, restlessness, anxiety, dizziness, tinnitus, blurred vision, tremors (possible convulsions), chills, constriction of the pupils, elevated temperature, paralysis of the of consciousness, persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities/sphincter control, headache, septic meningitis, meningismus, cranial nerve palsies due to traction on nerves from of cerebrospinal fluid Urticaria, pruritus, erythema, excessive sweating Nausea, vomiting Backache Urinary retention, fecal/urinary incontinence Sneezing, respiratory paralysis (secondary to spinal block) Loss of perineal sensation and sexual function Anaphylactoid-like symptomatology (including severe hypotension) Slowing of labor; increased incidence of forceps delivery

Mechanism of Action

Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold